Giant Hydatid Cyst with Diaphragmatic, Pericardial, and Hepatic Involvement: Use of Extracorporeal Circulation for Major Liver Resection: A Case Report and Literature Review

Objective: Rare diseaseBackground: Echinococcosis is a zoonosis caused by the echinococcus microorganism, a parasite with 6 described species in the literature, the main one in humans being Echinococcus granulosus. Transmission is via the fecal-oral route, with main hepatopulmonary involvement but with high risk of dissemination. Diagnosis is often incidental and patients present a wide range of non-specific symptoms, closely related to localization, size, and quanti-ty of cysts. The latent risk of the infection is septic shock secondary to intraperitoneal rupture, which increas-es the risk of mortality. The criterion standard of management involves anthelmintic therapy and radical sur-gical management.Case Report: We present the case of a man in the third decade of life from a rural area of Colombia, presenting abdominal pain and febrile peaks for 2 months. Imaging studies showed a cystic lesion with thoracic and hepatic involve-ment. He was treated in 2 surgical stages, the first achieving partial resection of the cyst involving lung, dia-phragm, and rib cage, and the second with extracorporeal circulation assistance due to infiltration of the ret-rohepatic vena cava, achieving radical resection of the disease.Conclusions: Echinococcosis is a condition endemic to rural areas, with wide geographical distribution. Given the slow growth, it is mostly asymptomatic, which causes diagnostic and therapeutic challenges involving high rates of compli-cations and mortality. An individualized surgical and medical approach is recommended. Extracorporeal circu-lation assistance helps achieve hemodynamic stability in patients with cardiac or great vessel involvement. To the best of our knowledge, this is the first report of extracorporeal circulation assistance for large hepatic -di-aphragmatic and pericardial cyst resection.